Abstract
INTRODUCTION: The incidence of purulent destructive lung diseases including pleural empyema (PE) is increasing worldwide. Prognosis of the course and outcome is needed to personalize monitoring and care of PE patients as well as assess if previous coronavirus disease 2019 (COVID-19) may affect prognostic value of a biomarker. OBJECTIVE: Identification of inflammatory markers of course and outcome of PE developed after community-acquired pneumonia and determine the dependence of their prognostic value on previous COVID-19 in anamnesis. MATERIALS AND METHODS: The study included hospitalised post-community-acquired pneumonia PE patients (n = 216, age 18–87 years). Mann–Whitney U-criterion was used to assess significance of differences between groups. Odds ratios (OR) and 95 % confidence intervals (95% CI) were calculated. Kaplan–Meier method and log-rank test were used to determine differences in survival. RESULTS: Depending on the PE course (patients with and without fistula), the RDW (Red Cell Distribution Width) values were differed, as recorded on the third (p = 0.039), fifth (p = 0.018) and last days (p = 0.007) of hospitalization. Raised RDW value (Hazard Ratio (HR) = 2.4; 95 % confidence interval (CI) 1.0–5.6; р = 0.0454, log-rank test, n = 216) and C-reactive protein (CRP) level increase (HR = 3.5; 95% CI 1.4–8.5; р = 0.0036, log-rank test, n = 216) on the first day of hospitalization predicted the unfavourable outcome in the whole cohort of patients with PE. In patients with no PCR-proved COVID-19 in anamnesis, RDW value increased on the first day of hospitalization predicting unfavourable outcome (HR = 2.8; 95% CI 1.0–7.7; р = 0.0319, log-rank test, n = 135). In post-COVID-19 patients, increased CRP value and extended RDW level were not significantly associated with poor outcome. CONCLUSIONS: CRP level predicted mortality only in a whole cohort of patients with pleural empyema; the significance of prediction was lost in a subgroup of patients with a previous PCR-proved COVID-19. Increased RDW value on the first day of hospitalization predicted unfavourable outcome only in patients with no PCR-proved anamnestic COVID-19.
Publisher
Practical Medicine Publishing House
Reference49 articles.
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